|
IMPLT STEM FRACTURE HUMERAL 8MM
|
Facility
|
IP
|
$17,497.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002568
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,998.80 |
| Max. Negotiated Rate |
$16,622.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$13,997.60
|
| Rate for Payer: Cash Price |
$10,498.20
|
| Rate for Payer: Cash Price |
$10,498.20
|
| Rate for Payer: Cigna Commercial |
$14,872.45
|
| Rate for Payer: First Health Commercial |
$15,747.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$15,747.30
|
| Rate for Payer: GEHA Commercial |
$12,247.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$15,747.30
|
| Rate for Payer: Multiplan All |
$15,922.27
|
| Rate for Payer: OMNI Networks Commercial |
$12,247.90
|
| Rate for Payer: One Health Plan PPO/POS |
$15,747.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$16,622.15
|
| Rate for Payer: Three Rivers Provider Network All |
$13,122.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$16,272.21
|
| Rate for Payer: Zelis Auto |
$6,998.80
|
|
|
IMPLT STEM FRACTURE SIZE 8
|
Facility
|
OP
|
$15,118.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,779.50 |
| Max. Negotiated Rate |
$14,362.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9,070.80
|
| Rate for Payer: Cash Price |
$9,070.80
|
| Rate for Payer: Cash Price |
$9,070.80
|
| Rate for Payer: Cigna Commercial |
$12,850.30
|
| Rate for Payer: First Health Commercial |
$13,606.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13,606.20
|
| Rate for Payer: GEHA Commercial |
$12,094.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13,606.20
|
| Rate for Payer: Humana ChoiceCare |
$3,930.68
|
| Rate for Payer: Multiplan All |
$13,757.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,070.80
|
| Rate for Payer: OMNI Networks Commercial |
$10,582.60
|
| Rate for Payer: One Health Plan PPO/POS |
$13,606.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14,362.10
|
| Rate for Payer: Three Rivers Provider Network All |
$11,338.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13,303.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,779.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14,059.74
|
| Rate for Payer: Zelis Auto |
$6,047.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,559.00
|
|
|
IMPLT STEM FRACTURE SIZE 8
|
Facility
|
IP
|
$15,118.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,047.20 |
| Max. Negotiated Rate |
$14,362.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12,094.40
|
| Rate for Payer: Cash Price |
$9,070.80
|
| Rate for Payer: Cash Price |
$9,070.80
|
| Rate for Payer: Cigna Commercial |
$12,850.30
|
| Rate for Payer: First Health Commercial |
$13,606.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13,606.20
|
| Rate for Payer: GEHA Commercial |
$10,582.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13,606.20
|
| Rate for Payer: Multiplan All |
$13,757.38
|
| Rate for Payer: OMNI Networks Commercial |
$10,582.60
|
| Rate for Payer: One Health Plan PPO/POS |
$13,606.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14,362.10
|
| Rate for Payer: Three Rivers Provider Network All |
$11,338.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14,059.74
|
| Rate for Payer: Zelis Auto |
$6,047.20
|
|
|
IMPLT STEM HIP 127 DEGREE NECK SIZE7
|
Facility
|
IP
|
$7,215.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.00 |
| Max. Negotiated Rate |
$6,854.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,772.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cigna Commercial |
$6,132.75
|
| Rate for Payer: First Health Commercial |
$6,493.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,493.50
|
| Rate for Payer: GEHA Commercial |
$5,050.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,493.50
|
| Rate for Payer: Multiplan All |
$6,565.65
|
| Rate for Payer: OMNI Networks Commercial |
$5,050.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,493.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,854.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,411.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,709.95
|
| Rate for Payer: Zelis Auto |
$2,886.00
|
|
|
IMPLT STEM HIP 127 DEGREE NECK SIZE7
|
Facility
|
OP
|
$7,215.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,803.75 |
| Max. Negotiated Rate |
$6,854.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cigna Commercial |
$6,132.75
|
| Rate for Payer: First Health Commercial |
$6,493.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,493.50
|
| Rate for Payer: GEHA Commercial |
$5,772.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,493.50
|
| Rate for Payer: Humana ChoiceCare |
$1,875.90
|
| Rate for Payer: Multiplan All |
$6,565.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,329.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,050.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,493.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,854.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,411.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,349.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,803.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,709.95
|
| Rate for Payer: Zelis Auto |
$2,886.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,607.50
|
|
|
IMPLT STEM HIP 132 DEGREE #4 35MMX105MM
|
Facility
|
OP
|
$7,215.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,803.75 |
| Max. Negotiated Rate |
$6,854.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cigna Commercial |
$6,132.75
|
| Rate for Payer: First Health Commercial |
$6,493.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,493.50
|
| Rate for Payer: GEHA Commercial |
$5,772.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,493.50
|
| Rate for Payer: Humana ChoiceCare |
$1,875.90
|
| Rate for Payer: Multiplan All |
$6,565.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,329.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,050.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,493.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,854.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,411.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,349.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,803.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,709.95
|
| Rate for Payer: Zelis Auto |
$2,886.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,607.50
|
|
|
IMPLT STEM HIP 132 DEGREE #4 35MMX105MM
|
Facility
|
IP
|
$7,215.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.00 |
| Max. Negotiated Rate |
$6,854.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,772.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cigna Commercial |
$6,132.75
|
| Rate for Payer: First Health Commercial |
$6,493.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,493.50
|
| Rate for Payer: GEHA Commercial |
$5,050.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,493.50
|
| Rate for Payer: Multiplan All |
$6,565.65
|
| Rate for Payer: OMNI Networks Commercial |
$5,050.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,493.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,854.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,411.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,709.95
|
| Rate for Payer: Zelis Auto |
$2,886.00
|
|
|
IMPLT STEM HIP 132 DEGREE NECK ANGLE # 6
|
Facility
|
OP
|
$7,215.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,803.75 |
| Max. Negotiated Rate |
$6,854.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cigna Commercial |
$6,132.75
|
| Rate for Payer: First Health Commercial |
$6,493.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,493.50
|
| Rate for Payer: GEHA Commercial |
$5,772.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,493.50
|
| Rate for Payer: Humana ChoiceCare |
$1,875.90
|
| Rate for Payer: Multiplan All |
$6,565.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,329.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,050.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,493.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,854.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,411.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,349.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,803.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,709.95
|
| Rate for Payer: Zelis Auto |
$2,886.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,607.50
|
|
|
IMPLT STEM HIP 132 DEGREE NECK ANGLE # 6
|
Facility
|
IP
|
$7,215.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.00 |
| Max. Negotiated Rate |
$6,854.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,772.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cigna Commercial |
$6,132.75
|
| Rate for Payer: First Health Commercial |
$6,493.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,493.50
|
| Rate for Payer: GEHA Commercial |
$5,050.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,493.50
|
| Rate for Payer: Multiplan All |
$6,565.65
|
| Rate for Payer: OMNI Networks Commercial |
$5,050.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,493.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,854.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,411.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,709.95
|
| Rate for Payer: Zelis Auto |
$2,886.00
|
|
|
IMPLT STEM HIP 132 DEGREE SIZE 7
|
Facility
|
OP
|
$9,592.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002300
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,398.00 |
| Max. Negotiated Rate |
$9,112.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,755.20
|
| Rate for Payer: Cash Price |
$5,755.20
|
| Rate for Payer: Cash Price |
$5,755.20
|
| Rate for Payer: Cigna Commercial |
$8,153.20
|
| Rate for Payer: First Health Commercial |
$8,632.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,632.80
|
| Rate for Payer: GEHA Commercial |
$7,673.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,632.80
|
| Rate for Payer: Humana ChoiceCare |
$2,493.92
|
| Rate for Payer: Multiplan All |
$8,728.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,755.20
|
| Rate for Payer: OMNI Networks Commercial |
$6,714.40
|
| Rate for Payer: One Health Plan PPO/POS |
$8,632.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,112.40
|
| Rate for Payer: Three Rivers Provider Network All |
$7,194.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,440.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,398.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,920.56
|
| Rate for Payer: Zelis Auto |
$3,836.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,796.00
|
|
|
IMPLT STEM HIP 132 DEGREE SIZE 7
|
Facility
|
IP
|
$9,592.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002300
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,836.80 |
| Max. Negotiated Rate |
$9,112.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,673.60
|
| Rate for Payer: Cash Price |
$5,755.20
|
| Rate for Payer: Cash Price |
$5,755.20
|
| Rate for Payer: Cigna Commercial |
$8,153.20
|
| Rate for Payer: First Health Commercial |
$8,632.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,632.80
|
| Rate for Payer: GEHA Commercial |
$6,714.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,632.80
|
| Rate for Payer: Multiplan All |
$8,728.72
|
| Rate for Payer: OMNI Networks Commercial |
$6,714.40
|
| Rate for Payer: One Health Plan PPO/POS |
$8,632.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,112.40
|
| Rate for Payer: Three Rivers Provider Network All |
$7,194.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,920.56
|
| Rate for Payer: Zelis Auto |
$3,836.80
|
|
|
IMPLT STEM HIP ANGLE DEGREE 132
|
Facility
|
IP
|
$7,215.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002149
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.00 |
| Max. Negotiated Rate |
$6,854.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,772.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cigna Commercial |
$6,132.75
|
| Rate for Payer: First Health Commercial |
$6,493.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,493.50
|
| Rate for Payer: GEHA Commercial |
$5,050.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,493.50
|
| Rate for Payer: Multiplan All |
$6,565.65
|
| Rate for Payer: OMNI Networks Commercial |
$5,050.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,493.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,854.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,411.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,709.95
|
| Rate for Payer: Zelis Auto |
$2,886.00
|
|
|
IMPLT STEM HIP ANGLE DEGREE 132
|
Facility
|
OP
|
$7,215.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,803.75 |
| Max. Negotiated Rate |
$6,854.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cigna Commercial |
$6,132.75
|
| Rate for Payer: First Health Commercial |
$6,493.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,493.50
|
| Rate for Payer: GEHA Commercial |
$5,772.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,493.50
|
| Rate for Payer: Humana ChoiceCare |
$1,875.90
|
| Rate for Payer: Multiplan All |
$6,565.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,329.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,050.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,493.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,854.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,411.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,349.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,803.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,709.95
|
| Rate for Payer: Zelis Auto |
$2,886.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,607.50
|
|
|
IMPLT STEM HIP ANGLE DEGREE 132
|
Facility
|
OP
|
$7,215.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,803.75 |
| Max. Negotiated Rate |
$6,854.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cigna Commercial |
$6,132.75
|
| Rate for Payer: First Health Commercial |
$6,493.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,493.50
|
| Rate for Payer: GEHA Commercial |
$5,772.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,493.50
|
| Rate for Payer: Humana ChoiceCare |
$1,875.90
|
| Rate for Payer: Multiplan All |
$6,565.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,329.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,050.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,493.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,854.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,411.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,349.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,803.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,709.95
|
| Rate for Payer: Zelis Auto |
$2,886.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,607.50
|
|
|
IMPLT STEM HIP ANGLE DEGREE 132
|
Facility
|
IP
|
$7,215.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.00 |
| Max. Negotiated Rate |
$6,854.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,772.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cigna Commercial |
$6,132.75
|
| Rate for Payer: First Health Commercial |
$6,493.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,493.50
|
| Rate for Payer: GEHA Commercial |
$5,050.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,493.50
|
| Rate for Payer: Multiplan All |
$6,565.65
|
| Rate for Payer: OMNI Networks Commercial |
$5,050.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,493.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,854.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,411.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,709.95
|
| Rate for Payer: Zelis Auto |
$2,886.00
|
|
|
IMPLT STEM HIP ANGLE DEGREE 132
|
Facility
|
OP
|
$7,215.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002149
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,803.75 |
| Max. Negotiated Rate |
$6,854.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cigna Commercial |
$6,132.75
|
| Rate for Payer: First Health Commercial |
$6,493.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,493.50
|
| Rate for Payer: GEHA Commercial |
$5,772.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,493.50
|
| Rate for Payer: Humana ChoiceCare |
$1,875.90
|
| Rate for Payer: Multiplan All |
$6,565.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,329.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,050.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,493.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,854.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,411.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,349.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,803.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,709.95
|
| Rate for Payer: Zelis Auto |
$2,886.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,607.50
|
|
|
IMPLT STEM HIP ANGLE DEGREE 132
|
Facility
|
IP
|
$7,215.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.00 |
| Max. Negotiated Rate |
$6,854.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,772.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cigna Commercial |
$6,132.75
|
| Rate for Payer: First Health Commercial |
$6,493.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,493.50
|
| Rate for Payer: GEHA Commercial |
$5,050.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,493.50
|
| Rate for Payer: Multiplan All |
$6,565.65
|
| Rate for Payer: OMNI Networks Commercial |
$5,050.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,493.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,854.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,411.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,709.95
|
| Rate for Payer: Zelis Auto |
$2,886.00
|
|
|
IMPLT STEM HIP ANGLE NECK 127 27X96MM
|
Facility
|
OP
|
$7,215.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,803.75 |
| Max. Negotiated Rate |
$6,854.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cigna Commercial |
$6,132.75
|
| Rate for Payer: First Health Commercial |
$6,493.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,493.50
|
| Rate for Payer: GEHA Commercial |
$5,772.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,493.50
|
| Rate for Payer: Humana ChoiceCare |
$1,875.90
|
| Rate for Payer: Multiplan All |
$6,565.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,329.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,050.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,493.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,854.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,411.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,349.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,803.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,709.95
|
| Rate for Payer: Zelis Auto |
$2,886.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,607.50
|
|
|
IMPLT STEM HIP ANGLE NECK 127 27X96MM
|
Facility
|
IP
|
$7,215.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.00 |
| Max. Negotiated Rate |
$6,854.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,772.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cigna Commercial |
$6,132.75
|
| Rate for Payer: First Health Commercial |
$6,493.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,493.50
|
| Rate for Payer: GEHA Commercial |
$5,050.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,493.50
|
| Rate for Payer: Multiplan All |
$6,565.65
|
| Rate for Payer: OMNI Networks Commercial |
$5,050.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,493.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,854.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,411.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,709.95
|
| Rate for Payer: Zelis Auto |
$2,886.00
|
|
|
IMPLT STEM HIP ANGLE NECK 127 DEGREE
|
Facility
|
OP
|
$7,215.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002150
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,803.75 |
| Max. Negotiated Rate |
$6,854.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cigna Commercial |
$6,132.75
|
| Rate for Payer: First Health Commercial |
$6,493.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,493.50
|
| Rate for Payer: GEHA Commercial |
$5,772.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,493.50
|
| Rate for Payer: Humana ChoiceCare |
$1,875.90
|
| Rate for Payer: Multiplan All |
$6,565.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,329.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,050.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,493.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,854.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,411.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,349.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,803.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,709.95
|
| Rate for Payer: Zelis Auto |
$2,886.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,607.50
|
|
|
IMPLT STEM HIP ANGLE NECK 127 DEGREE
|
Facility
|
IP
|
$7,215.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002150
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.00 |
| Max. Negotiated Rate |
$6,854.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,772.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cigna Commercial |
$6,132.75
|
| Rate for Payer: First Health Commercial |
$6,493.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,493.50
|
| Rate for Payer: GEHA Commercial |
$5,050.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,493.50
|
| Rate for Payer: Multiplan All |
$6,565.65
|
| Rate for Payer: OMNI Networks Commercial |
$5,050.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,493.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,854.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,411.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,709.95
|
| Rate for Payer: Zelis Auto |
$2,886.00
|
|
|
IMPLT STEM HIP ANGLE NECK 127DEG SIZE 5
|
Facility
|
OP
|
$7,215.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002165
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,803.75 |
| Max. Negotiated Rate |
$6,854.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cigna Commercial |
$6,132.75
|
| Rate for Payer: First Health Commercial |
$6,493.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,493.50
|
| Rate for Payer: GEHA Commercial |
$5,772.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,493.50
|
| Rate for Payer: Humana ChoiceCare |
$1,875.90
|
| Rate for Payer: Multiplan All |
$6,565.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,329.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,050.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,493.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,854.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,411.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,349.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,803.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,709.95
|
| Rate for Payer: Zelis Auto |
$2,886.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,607.50
|
|
|
IMPLT STEM HIP ANGLE NECK 127DEG SIZE 5
|
Facility
|
IP
|
$7,215.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002165
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.00 |
| Max. Negotiated Rate |
$6,854.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,772.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cigna Commercial |
$6,132.75
|
| Rate for Payer: First Health Commercial |
$6,493.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,493.50
|
| Rate for Payer: GEHA Commercial |
$5,050.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,493.50
|
| Rate for Payer: Multiplan All |
$6,565.65
|
| Rate for Payer: OMNI Networks Commercial |
$5,050.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,493.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,854.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,411.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,709.95
|
| Rate for Payer: Zelis Auto |
$2,886.00
|
|
|
IMPLT STEM HIP ANGLE NECK 127DEG SZ6
|
Facility
|
IP
|
$7,215.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.00 |
| Max. Negotiated Rate |
$6,854.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,772.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cigna Commercial |
$6,132.75
|
| Rate for Payer: First Health Commercial |
$6,493.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,493.50
|
| Rate for Payer: GEHA Commercial |
$5,050.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,493.50
|
| Rate for Payer: Multiplan All |
$6,565.65
|
| Rate for Payer: OMNI Networks Commercial |
$5,050.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,493.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,854.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,411.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,709.95
|
| Rate for Payer: Zelis Auto |
$2,886.00
|
|
|
IMPLT STEM HIP ANGLE NECK 127DEG SZ6
|
Facility
|
OP
|
$7,215.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7001876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,803.75 |
| Max. Negotiated Rate |
$6,854.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cash Price |
$4,329.00
|
| Rate for Payer: Cigna Commercial |
$6,132.75
|
| Rate for Payer: First Health Commercial |
$6,493.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,493.50
|
| Rate for Payer: GEHA Commercial |
$5,772.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,493.50
|
| Rate for Payer: Humana ChoiceCare |
$1,875.90
|
| Rate for Payer: Multiplan All |
$6,565.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,329.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,050.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,493.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,854.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,411.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,349.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,803.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,709.95
|
| Rate for Payer: Zelis Auto |
$2,886.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,607.50
|
|
